Dr. G: Medical Examiner - Season 6, Episode 1 - Fatal Flaw - Full Episode | Forensic Files

[MUSIC PLAYING] NARRATOR: When a seemingly healthy infant dies suddenly-- Oh my god!
The mother notices the lips are turning blue, she takes it out of the car seat and it kind of
gasp and dies in her arms. NARRATOR: Dr. G finds herself knee deep in what could be an unsolvable case.
There's a lot of subtleties in trying to figure out why the baby died. NARRATOR: Then, a man rushes to the hospital
with stomach pains, but his discharge that same afternoon. The abdominal pain subsided, so they let him go home.
NARRATOR: And when he dies just two days later, his wife believes the hospital is to blame.
The wife is devastated. So now we've got to sort out what's going on. [OPENING THEME]
NARRATOR: Altered lives, baffling medical mysteries, shocking revelations. These are the everyday cases of Dr. G, medical examiner.
[MUSIC PLAYING] To an outsider, the busy District 9 morgue in Orlando, Florida with its strange sights, noises, and smells
can seem overwhelming. But after 21 years on the job, chief medical examiner Dr. Jan
Garavaglia-- That's a lot of trauma. NARRATOR: --has mastered the art of staying
focused no matter what. [BEEP] VOICE OVER PA: Dr. Garavaglia, please call extension 03.
They're calling my name. I don't like being interrupted in the middle of an autopsy.
I don't like phone calls in the middle of an autopsy. What's up Tommy? I don't like a lot of visitors in the morgue
because I don't like people chatting with me. What is happened to-today? MORGUE ATTENDANT 1: It's a brain [INAUDIBLE]
I know, that brain fruit. - What is that chitchat? - [LAUGHS] MORGUE ATTENDANT 2: Chitchat.
If we don't chitchat, we get done fast. OK, no talking. You know, I'm working, and they don't
understand me being quiet. It means I'm thinking. [INAUDIBLE] wanted to come down for this baby, but we
didn't know what time to tell. NARRATOR: And no case requires more attention and focused than the death of a child.
This is a little girl that was left in the car. That's the tragedy of the day, It's always sad
when babies come to the morgue. But also, the autopsies are harder in that. There are so many subtleties in trying to figure
out why the baby died. This baby wasn't born alive. Because each one is unique, and you never know
what the answer is going to be. NARRATOR: One of Dr. G's most confounding child deaths
occurred several years ago when she served as medical examiner at the Bexar County Morgue
in San Antonio, Texas. [SUSPENSEFUL MUSIC] It's a crisp September morning in Laredo, Texas.
And 25-year-old, Armando Gaytan is changing the diaper of his six-month-old daughter, Anna.
[TENSE MUSIC] Anna? The father noticed that the baby wasn't quite acting right. She just wasn't moving as much, particularly,
couldn't lift her head up where she could be for. What's the matter? Anna, wake up!
Sophia! NARRATOR: Panicked, Armando and his wife, Sophia rushed their daughter to the nearest hospital.
[TENSE MUSIC] DR. GARAVAGLIA: The father's , driving the mother's in the backseat with the baby.
They were moments away from the hospital. Oh my god! She notices that the lips are turning blue.
[INAUDIBLE] DR. GARAVAGLIA: She takes it out of the car seat, and it kind of gasp and dies in her arms.
(CRYING) Oh my god. DR. GARAVAGLIA: They, of course, try to resuscitate it in the hospital.
Charging three, two, one, clear! Unfortunately, the baby didn't come back. This family, it's a young mom and dad,
and they were devastated by it. I can't imagine what they're going through. Babies aren't supposed to die.
They deserve an answer. [SUSPENSEFUL MUSIC] Today, we have a precious little six-month-old girl
that died in the car while the parents were taken her to the hospital. In our office, we probably average
anywhere from 40 to 50 babies a year that come through our morgue. So maybe a little less than one a week.
When we see children in the morgue, it tends to be infants, particularly, six months and younger.
Once they get past a year, that's a very unusual group. And then it starts picking up again in the pre-teen years
with suicides and accidents. But certainly, it's that first year of life that we see most often.
So Arden is taking a picture of her. Let's see what I can find in here. NARRATOR: Dr. G's first order of business
is to carefully read through the investigators report. Let's see. NARRATOR: According to the Gaytans,
their daughter was a perfectly healthy baby but had recently suffered what doctors believed to have been
a mild respiratory infection. DR. GARAVAGLIA: The baby had just finished about a 10-day course of antibiotics for a kind
of cold-like symptoms. I don't know if that's going to be relevant or not. NARRATOR: But she knows that what
may seem like a harmless cold can have disastrous consequences in an infant. DR. GARAVAGLIA: Babies tend to get infections very quickly.
Maybe it wasn't properly treated, maybe it's gotten pneumonia, maybe it's gone to meningitis.
That is a real possibility. Do you want to look at the back too? No, that's all.
Just overall. NARRATOR: But Dr. G must also rule out another likely culprit, a birth defect.
There are some that are just very difficult to diagnose. And they present with sudden death.
It can be everything from bowels, to heart, to lungs, even some brain congenital abnormalities.
NARRATOR: But if all the suspects on her list, none is more sinister or heartbreaking
than the possibility of physical abuse. [BABY CRYING] It's hard to believe anybody would inflict trauma on a baby.
But unfortunately, I see it multiple times a year. You know, the baby's been sick.
I'm sure it's been fussy. It's a relatively young parents. Maybe they got to their wit's end.
[SUSPENSEFUL MUSIC] [BABY CRYING] [TENSE MUSIC] DR. GARAVAGLIA: It's usually very poor parenting skills.
They do it in frustration, and they're very sorrowful afterwards. Not all of them, but it often is an impulsive act.
And one parent may have no idea what the other parent did. [SUSPENSEFUL MUSIC] The father is alone with the baby changing the diaper
and then comes up with the story that it's not acting right. Is it not acting right after he threw
it and hit its head on the edge of the changing table? Or is that story true? We never take anything at face value.
We always have to further investigate. We'll take their story as true but take it
with a grain of salt and see if there's any forensic evidence that either proves
it or disputes it. So we're hoping that we have an answer when we do this autopsy,
but I have a feeling it's going to take a long time. There's a lot of possibilities here, everything from trauma,
to infection, to congenital abnormalities, there's a lot of things that can happen to an infant.
[SUSPENSEFUL MUSIC] A lot of people have trouble dealing with autopsies on babies.
I know, my staff do not like to all watch them. NARRATOR: But when Dr. G approaches
the examination table, it is as an objective scientist. DR. GARAVAGLIA: I'm in the medical examiner doctor mode.
You want to give me the tape measure? I'll measure, I'll weigh the baby. It's a beautiful little baby as most of them are.
I'll look for any kind of dysmorphic features, meaning, the face isn't right or the hands aren't right.
Anything that maybe points to any kind of congenital syndrome, but everything looks normal on this baby.
Big dark brown eyes. Routinely, we'll look at the palms of the hands. If you look at the creases on your hand,
you'll see they criss-cross. Sometimes, with some congenital abnormalities of strictly down syndrome, they'll have
some abnormal palmar creases. This is one that just goes across the palm from side
to side. NARRATOR: But the palm creases on baby Anna are normal. DR. GARAVAGLIA: We look to see if the baby looks sick.
If there's any rashes or bleeding underneath the skin. Eyes, OK. NARRATOR: But a thorough inspection reveals
nothing out of the ordinary. Beautiful baby. It's hard to believe that it had been sick.
The baby looks really healthy. Her trained eye does pick up subtle puncture marks on
the surface of the baby's skin. But these are hardly surprising. That baby also has a lot of needle marks.
Clearly, they tried to resuscitate it. They were trying to get vascular access to give that baby
medication and fluids to bring its blood pressure up, to bring its heart back. Unfortunately, they were unsuccessful.
NARRATOR: Finally, she checks for any signs of physical trauma. I palpate the head.
I don't see anything wrong with the facial features. The neck is normal. There's no bruises to the abdomen.
The genitalia looks normal. I don't see any evidence of any external trauma. NARRATOR: But unfortunately, this doesn't mean
that the baby was not abused. DR. GARAVAGLIA: No trauma on the outside doesn't mean no trauma on the inside.
Believe it or not, in at least 10% of the cases, you're not going to see anything external.
And it's not until we do the autopsy that you discover the trauma. We'll just have to wait and see.
NARRATOR: In the meantime, Dr. G is determined to leave no stone unturned. Please do.
NARRATOR: So she orders an X-ray of the infant's entire body, including her arms and legs.
So we'll make sure there's no problem on her. We're looking for old fractures and recent fractures.
Because that often will be indicative of abuse. But on this baby, I don't see anything.
NARRATOR: Despite the absence of fractures, abuse is still a prime suspect. Just because the X-rays are normal,
that doesn't mean they're still not internal trauma. We'll see what we find at autopsy.
[MUSIC PLAYING] DR. GARAVAGLIA: Everything is still in play. It still can be everything from trauma,
to infection, to congenital abnormality. I don't know. I'm hoping the autopsy will give me the answer.
[TENSE MUSIC] NARRATOR: At the Bexar County Morgue in San Antonio, Texas, Dr. G is ready to autopsy six-month-old Anna Gaytan, who
died suddenly after recovering from an apparent respiratory infection. As with all cases of infant death,
abuse is always high on her list of suspects. We'll make sure that the autopsy doesn't show any foul play.
NARRATOR: And with so much at stake, the pressure to close the investigation is mounting.
DR. GARAVAGLIA: The parents are under a cloud of suspicion. If we find any type of inflicted trauma,
I will immediately call law enforcement. I have to get the answers. NARRATOR: To completely rule out abuse,
she must look for evidence internally, starting with the head. It just something to hold her head a little bit.
The head trauma is the number one inflicted trauma in infants. Although there is no external trauma,
I've been fooled before. Believe it or not, sometimes you just don't see it. [MUSIC PLAYING]
NARRATOR: Dr. G begins by cutting a slit across the back of Anna's head from ear to ear,
freeing the scalp. I'll reflect the scalp and look for contusions. I'll look for evidence of impact,
but I don't see anything. Go hit her. NARRATOR: Morgue technician, Arden Monroe,
uses an oscillating saw to cut through Anna's soft skull. Babies skulls are different only that they're thinner,
and they're a little smoother. They're a little easier to cut. But we still need a saw.
The only ones that we can actually open through the sutures are the newborns, the really, really
young babies. We can just open up where the bones are coming together. But once you get to be six months,
the bone is firm enough that we need a saw NARRATOR: Next, Dr. G opens the calvarium or skull cap,
exposing Anna's brain. We're looking for any kind of blood, and there isn't on this baby.
There is no evidence of bleeding that would indicate trauma. I don't think we'll need the brain bucket.
There's still a possibility of trauma in the chest and abdomen, but that's going down on my probabilities.
NARRATOR: But this cranial exam is far from over. Before she can proceed with the rest of the autopsy,
one last suspect must be eliminated, bacterial meningitis. Meningitis is an inflammation of meninges or of the covering
of the brain. And babies can get meningitis and go downhill very quickly. And if left untreated, it can often prove fatal.
[SUSPENSEFUL MUSIC] DR. GARAVAGLIA: Babies have different symptoms than adults. With an adult, they'd complain of a headache.
Well, baby is not going to complain of a headache. They just may be irritable, or they
may just get sicker and sicker and being real lethargic. NARRATOR: If Anna died from bacterial meningitis,
chances are Dr. G will be able to tell by examining the thin membrane covering her brain.
We look to see if that's cloudy or any evidence of infection. And in this case, there isn't.
The brain looks completely normal. All righty, I'm going to leave it in your capable hands.
NARRATOR: But her many years in the morgue have made her wary of jumping to conclusions.
Just because it's not cloudy, it doesn't mean that the baby doesn't have a meningitis.
I've been fooled before. Let's cut that brain. You never can rule out anything with a baby
until you look under the microscope. NARRATOR: But first, she's hoping that the internal exam will provide
some more definitive answers. [TENSE MUSIC] Surprisingly, performing an autopsy on an infant
is easier than on an adult. Babies don't have a lot of heavy fat on them. Things are usually pink.
They don't have signs of smoking or obesity. They're beautiful, perfect little specimens and either
just usually so pristine. NARRATOR: But they do require an entirely different set of tools.
When you autopsy a baby, I'll use the same scalpel. But we'll use smaller scissors, we'll use, usually, smaller
needles, smaller syringes. And I have to use a smaller scale because the organs are so much smaller.
They don't weigh on my-- our regular hanging scale. So we'll use a small digital scale for the baby organs.
NARRATOR: As with an adult, Dr. G begins by performing the standard Y-incision. Immediately, when I open the body,
I look to see if there's any evidence of trauma, blood collected in any of the body cavities.
And I really don't see anything. There is no free blood in the belly. They take the chest plate off.
I look for any rib fractures. Everything looks fine. There's no evidence of any kind of inflicted injury.
NARRATOR: At this point, she is still without a cause of death. But one thing is certain.
We know that trauma didn't contribute to this baby's death. We've cleared the family of any kind of wrongdoing.
NARRATOR: Dr. G's next priority is to collect blood samples for forensic analysis.
DR. GARAVAGLIA: Before I do anything else, let's see if we can get a little bit of blood here.
I'll take blood sterilely. How are we doing? And we'll send that off to see if any bacteria
is present in the body. NARRATOR: With the organs exposed, She can now carefully inspect them for any signs
of congenital abnormalities. We give a once over to all the organs while they're still in the body, and everything
looks relatively normal. The heart is situated right, the great vessels go to the heart
correctly, everything looks to be in its normal spot. NARRATOR: Next, she begins the meticulous process of removing
and dissecting Anna's internal organs, one by one, starting with the heart. When I look at the heart, the heart looks normal.
OK, so her heart looks good. But it's normal size, shape, normal size weight for its age.
NARRATOR: Next stop, the lungs. There's a little bit of congestion. We often see that with resuscitation.
But overall, they don't look that bad. NARRATOR: But as Dr. G digs deeper inside Anna's tiny body,
she spots something amiss. What's interesting is, there's no food in the stomach.
You don't want to cut that bowel when you open it. What that tells me is that, this baby
hasn't eaten for a while. NARRATOR: It's too early to say whether this finding played
any part in Anna's death. DR. GARAVAGLIA: It could just be because the child has been getting over a cold.
Possibly, there have been vomiting or diarrhea. So it could be just a red herring.
NARRATOR: And incredibly, as Dr. G moves through the remaining organs, they yield little in the way of clues.
She's looking pretty good on the inside. NARRATOR: That is until she gets to the liver.
DR. GARAVAGLIA: It is one big liver, huh? The liver looks a little large, it looks pale,
and it's a little soften. Funky color. It looks like a fatty liver, but you know,
the baby shouldn't have fat in the liver. NARRATOR: Something is clearly wrong with baby Anna's liver.
DR. GARAVAGLIA: The liver is not looking good, I can tell. NARRATOR: But the question is, did
it play a role in her death? Even though I can't say specifically what's wrong with the liver, I'm hoping that will hold the key
to the answer to this case. OK, let's see. I have to take microbes of it. I'll definitely need to look at that under the microscope.
I'll just grab a bunch of fluids. NARRATOR: Dr. G takes tissue samples of the infant's liver,
as well as her other major organs. These will be mounted onto slides for microscopic examination.
The autopsy of baby Anna Gaytan has now come to an end. Unfortunately, her death certificate
still remains blank. Well, the autopsy is done but I think the work's just starting.
Everybody thinks once you finish the autopsy, you're going to have all the answers.
And that isn't necessarily so, particularly, with babies. Oftentimes, we have to look a little further for an answer.
If the answer comes simply, I will they please. But I doubt very well. NARRATOR: The microscopic slides along with the blood cultures
are now Dr. G's last chance of uncovering the truth behind Anna's tragic death. I always worry whenever I do an autopsy that I'm
not going to have an answer. That just comes with the nature of the job. And sometimes I don't have an answer.
[TENSE MUSIC] That one took a lot longer than I wanted it to. NARRATOR: It's been two weeks since the autopsy
of six-month-old Anna Gaytan. And as Dr. G waits for her cultures and microscopic slides
to come back from the lab, she worries that this could be one of those cases that never gets closed.
It's going to be difficult to figure this out if it's not clear cut. NARRATOR: As for Anna's parents, it's an agonizing limbo.
DR. GARAVAGLIA: Once a baby dies, there's tremendous consequences for them. Do they want to have another baby?
Why did this baby die? Are we going to chance that again? Maybe it's something wrong with us.
They want an answer. Ah-ah-ah. NARRATOR: But when Anna's talks report is finally delivered to the lab, it
unfortunately reveals nothing. My cultures were negative. Now I'm really worried.
My last hope is going to be in the microbes. [MUSIC PLAYING] NARRATOR: Four days later, she receives
the long awaited slides. The heart, the lungs, and the brain, all of those organs
looked normal. NARRATOR: This leaves only one place left to look for an explanation.
The liver, I'm hoping is what's going to give us that answer. NARRATOR: Under the powerful lens of the microscope,
the liver cells come into view. DR. GARAVAGLIA: I can see that it's abnormal. What it showed was a very fatty liver.
Much more fatty than I expected by just looking at the liver. Once I see that there is fat in the liver,
putting it all together with what I knew about the way it died, the fact that there's no food
in its stomach, that sets in motion in my mind a whole other cause of death. NARRATOR: Dr. G now believes she knows what killed baby Anna.
But speculation is not enough. She will need to order a special and unusual test to support her theory.
At the time, only a couple of research labs in the country were conducting this test.
But Dr. G finds one at the University of Texas in Dallas. And so I went ahead and sent a piece of liver, urine,
and blood off to the lab, hoping that they'll confirm my hunch. And as soon as I got the results back from the lab,
I knew I had my answer. NARRATOR: Dr. G is now able to reconstruct the simple tragedy
of baby Anna Gaytan short life. I was excited. It was great to feel right. I felt like I did some real, true medical detective work.
[SUSPENSEFUL MUSIC] NARRATOR: For the first six months of her life, baby Anna's tiny body functions normally.
This child doesn't have any problems until it gets a viral infection. NARRATOR: For most infants, a cold is harmless.
But in baby Anna's case, it's set into motion a fatal chain reaction. It's stress on its body.
And it also makes it not want to eat. NARRATOR: With no food coming in, Anna's body finds itself quickly running out of fuel.
At this point, a normal baby would simply tap into its reserves of stored body fat
to get the energy it needs to survive. But with baby Anna, there's an unexpected problem.
This is probably one of the first times in its life that it's really trying to break down a fat
because it was being fed well. But once it got that viral infection and it wasn't eating,
and then all of a sudden, Hey, I need some fuel here, let's break down so fats. Well, then it comes to light.
There's something wrong with the baby. NARRATOR: The lab results confirm that baby Anna was born
with an extremely rare genetic disorder called a fatty acid oxidation defect. What that means is that--
this poor kid can't break down fat. [TENSE MUSIC] NARRATOR: Because her body can't break down the fat,
it starts accumulating in her organs, mostly in the liver, which explains it's fatty appearance.
And that's not all. Because it couldn't utilize the fat for fuel, its blood sugar plummeted.
The combination of these two things are causing the baby to become lethargic and causing its muscles not to be
as strong as they normally are. NARRATOR: When his father, Armando, comes in to change her diaper, she barely has
the strength to raise her head. Anna, wake up! NARRATOR: That's when he and his wife, Sophia,
decide to rush their baby to the hospital. But by then, it's too late. DR. GARAVAGLIA: I don't think the baby's in pain.
It's dying from lack of fuel. And its brain's not going to function anymore. And that coupled with probably an arrhythmia
causes the baby to die suddenly. NARRATOR: A sad and abrupt end to a life cruelly cut short.
This is Dr. Garavaglia at the medical examiner's office. NARRATOR: All that remains is for Dr. G
to report her findings to Anna's parents. The family was shocked because the baby
acted normal to this point. How could it have such a thing. NARRATOR: And the Gaytans are still
reeling from the astonishing news when they're dealt another blow. What killed their baby girl could potentially
affect their future children. It's inherited, and that means that they have a 25% chance
of another child having this. If you have any questions, give me a call. NARRATOR: But fortunately, in recent years,
there have been tremendous advances in newborn screening tests for this rare condition.
Medicine has progressed since I did this case, and the technology's gotten better.
Now it would be no problem getting this tested. This is a very fulfilling case for me
because I came up with the answer. In 20 years, this isn't my only fatty acid deficiency.
They're very rare, but you still have to keep the rare in the back of your mind.
Because if you don't think about it, you're not going to find it. [MUSIC PLAYING]
NARRATOR: Dr. G uses every tool in her arsenal to solve a case, no matter how rare the cause of death may be.
But sometimes, the answers can only be found in the most unlikely of places. I'm really just left with no clues.
There's nothing that screams of why he died. [MUSIC PLAYING] Time to bring him on.
Oh gosh. DR. GARAVAGLIA: I just still can't believe you smoke. SANDY: I came on a smoke.
I know that smoking is addictive. We all live with somebody who smokes, somebody who's close to us.
And I have Sandy. I want to stop. You should really try. She sees everyday the effects that tobacco
can have on your body, and she's still has a difficult time quitting. That's how addicted she is.
NARRATOR: Dr. G knows it's not easy to kick the habit, which is evidenced in the case file of a young auto
mechanic named Jason Mitchell. DR. GARAVAGLIA: Well, this case is about a 34-year-old white male who would actually just been
in the ER two days earlier. So now, we've got to sort out what's going on. [SUSPENSEFUL MUSIC]
Well, we have this fellow that for about two days ago, starts having severe abdominal pain.
[GROANING] NARRATOR: In fact, the onset of pain is so sudden and so intense that Jason's wife, Patty, insists
he go to the emergency room. Upon his arrival, doctors begin running a battery of tests.
They find a whopping amount of cocaine in his system. NARRATOR: The medical team quickly
concluded that the cocaine is causing blood vessels in Jason's stomach to spasm.
And the pain would go away once the drug leaves his system. They just thought that this guy was just all high on coke.
They didn't seem to have any other problems. The abdominal pain subsided, so they let him go home.
With the caveat, you better stop using cocaine. Go home, get off the coke, you'll be fine.
NARRATOR: Jason and his wife returned home. And according to Patty, the medical scare
has a profound impact on him. He clearly told his wife, he's going to give up cocaine.
But over the next 24 hours, Jason continues to experience unusual symptoms. DR. GARAVAGLIA: He's sleeping more, he's lethargic,
he's really down, he's just not himself. A really groggy. NARRATOR: On his second day home,
he finally mustered the strength to get off the couch so he can make himself something to eat.
And he collapses suddenly. [THUMP] NARRATOR: Patty frantically calls 911. Emergency crews arrive within moments
and discovered Jason on the floor, not breathing and with no pulse. They swiftly begin aggressive lifesaving procedures,
but it's too late. They rushed him to the hospital, but he's already dead. [TENSE MUSIC]
[SIRENS WAILING] NARRATOR: For Jason's wife, Patty, his unexpected death is crushing.
The wife is devastated. She was hoping that he'd really, truly was going to overcome his addiction
and then have a new life with her without cocaine. NARRATOR: But cocaine addiction is difficult to overcome.
And now, Dr. G wonders if Jason actually followed through on his promise to kick the habit.
It's a long process to try to give up cocaine. It's not easy once you're a chronic abuser.
Most people have relapses. NARRATOR: And as a habitual cocaine user, Jason was at risk for all kinds of medical problems.
Cocaine can kill you in multiple ways. We've got strokes to the brain, we've got blown out aneurysms to the brain
because of the elevated high blood pressure. We can have problems with the heart.
NARRATOR: But Jason's wife Patty is convinced that he stopped using cocaine on the day he left the hospital.
On top of that, she suspects the doctors there may have misdiagnosed his condition entirely.
They always tell everyone, you know, if they've had a recent visit to a hospital or a doctor,
I mean, that's all the more reason to do the autopsy because we're going to look
to see if they missed anything. [SUSPENSEFUL MUSIC] You do the external examination
to see what you can learn about the person, about maybe their lifestyle. With him, they don't see a needle puncture marks.
I look for any chronic illnesses, I don't see any of that. And I certainly don't see any trauma.
NARRATOR: But Dr. G does notice that Jason has vomit in his mouth. DR. GARAVAGLIA: Typically, there are two orifices we have
problems with a death, It can be vomiting and having vomit up your nose and mouth
or you can defecate at death. Those are just sometimes reactions with the death.
And, you know, it really is very nonspecific for us. It doesn't really give us totally
a hint of why they died. NARRATOR: Next, she carefully inspects Jason's nose for any physical evidence of his long term drug
addiction. They can actually form a hole completely through the septum. That's a cocaine user when you see that.
He didn't have that. It's not the easiest thing to see. MORGUE ATTENDANT 3: [INAUDIBLE] with the light?
Nah, I'm fine. Fine. What color of eye would you say that? Green or blue green? Yeah, I say green.
Green? All right, let's go this way. NARRATOR: Then, Dr. G examines Jason's scalp
to see if there are any injuries from hitting his head when he collapsed. DR. GARAVAGLIA: When I palpate the external aspect
of his head, I don't see any bruises. I don't find anything abnormal. [SUSPENSEFUL MUSIC]
NARRATOR: Next, she turns her attention to the area that was causing Jason's pain, his abdomen.
DR. GARAVAGLIA: I do see that his abdomen is a little distended. It just as a little bigger than I expected.
He was innovated. And a lot of people, once they get innovated or they're CPR being done,
their stomachs do fill up with air. So it could just all be due to resuscitation.
At the end of the external, I'm really just left with no extra clues. We have no idea if this is a natural death,
or we have no idea if this is a an accidental death from using more cocaine. Certainly, the wife would like to know.
Maybe there's legal complications with even the ER missing a diagnosis. We don't know.
We're just-- we just-- let's get the facts out there and look what they are. [SUSPENSEFUL MUSIC]
NARRATOR: Dr. G is ready to open the body of 34-year-old Jason Mitchell. Just two days ago, Jason went to the ER with stomach pains.
But doctors attributed it to a cocaine binge and sent him home. Yet, his wife Patty is convinced that the doctors initially
misdiagnosed Jason's condition and is now anxiously awaiting word from Dr. G. DR. GARAVAGLIA: She is really worried.
She does know that he wasn't right. It just wasn't right after he came home from the hospital.
[TENSE MUSIC] NARRATOR: Dr. G begins with the cranial exam because she knows that cocaine can wreak havoc on the brain.
Well, there's a lot of ways cocaine can kill you. Everything from stroke to a baloney aneurysm.
NARRATOR: Using a scalpel, she cuts around the circumference of Jason's head. Dr. G is careful to draw the incision behind his ears.
DR. GARAVAGLIA: I just was talking the funeral home. They were mad about another medical examiner's
office that didn't quite do it behind the ears. That's really important because you
don't want to see the incision if you have an open casket. So you don't want it above the ears,
you don't want it cut in the ears. So you want it behind the ears and kind of low.
[SURGICAL SAW RUNNING] NARRATOR: Morgue technician, Ashley Shaughnessy, opens Jason's skull with an oscillating saw.
And right away, Dr. G can see that something's wrong. DR. GARAVAGLIA: When I look to the base of the skull,
there's no blown aneurysm. But he does have, at the age of 34, a fairly significant plaque
or narrowing at the base of his brain from atherosclerosis. NARRATOR: Atherosclerosis refers to a buildup of plaque
within the blood vessels. And it's commonly associated with cocaine use. Are you hardly ever see it at the base
of the brain at this age? 34, that's a really young. I see it in people that are 60, 70, 80.
So that's unusual. So that confirms that he probably is a big time cocaine user.
Cocaine causes accelerated to atherosclerosis and narrowing to the blood vessels, which increases
your chances of a stroke. NARRATOR: But as she examines Jason's brain more closely,
she can find no signs of an actual stroke. DR. GARAVAGLIA: I didn't find any evidence of that.
It actually looks normal on the inside. There's nothing that screams of why he died.
So I need to finish my autopsy at this point. [INTENSE MUSICAL BUILDUP] NARRATOR: Dr. G opens Jason's body with a Y-incision
and immediately draws blood for toxicology testing. DR. GARAVAGLIA: I want to draw my toxicology
to confirm what the ER said. Because they claim he was high on cocaine. I don't want to presume that their test is right,
so I'd like some confirmation. NARRATOR: She then turns her attention to the abdomen.
Dr. G wonders if the stomach pain could have been a sign of something more serious and unrelated
to Jason's cocaine use. There's a lot of reasons to have abdominal pain. Everything from appendicitis, to your bowels turning
on themselves, you know, you just don't know until you get in there. NARRATOR: Carefully, she searches each organ
for any abnormalities that might help explain Jason's stomach pain. DR. GARAVAGLIA: The abdominal cavity looks normal.
There's no fuzz, there's no blood, there's no free fluid. His appendix looks good.
These bowels are OK. At this point, I don't know what caused his abdominal pain.
Maybe that whole abdominal pain was a red herring and that the ER was right. It was just some temporary spasm.
But I haven't totally given up on that yet just because I don't see anything. It still could play a role.
NARRATOR: Unfortunately, Dr. G is running out of suspects. And her next stop is the last one
on her list, the chest cavity. I make my usual snip, snip, snip up the sides of those ribs.
And I remove the chest plate. And then I see trouble. This guy's got problem. Oh boy.
[SUSPENSEFUL MUSIC] Something's going on here. NARRATOR: Dr. G has just opened Jason Mitchell's chest
and come face-to-face with a shocking discovery. There was something wrong with the pericardial sac,
the protective membrane surrounding the heart. That sac has filled up with blood
and distended like a taped balloon that's ready to pop. NARRATOR: When the sac fills with blood,
the heart doesn't have enough room to beat properly. This is a deadly condition called a cardiac tamponade.
That's constricting that heart so it can't pump. That's just incompatible with life, I'm sorry.
We know why he died. NARRATOR: But the autopsy is far from over. DR. GARAVAGLIA: So then, you have to look for the cause.
Why does he have a cardiac tamponade? How does his pericardial sac get filled with blood?
It shouldn't have any blood in it at all. It should just have a little bit of fluid in there.
NARRATOR: Now she must examine the heart itself. But to do that she has to first drain the blood
from the pericardial sac. So to get that blood out, I just make a little cut. I don't want to make it too big, too fast
because it's going to blow. So I make a little cut and the stream comes up and then I collect that.
The first thing you see is that heart is huge. NARRATOR: In fact, Jason's heart is
triple the size it should be. This means, he most likely suffered from high blood
pressure or hypertension. If you have hypertension, the last thing you need is cocaine.
And I've said it before, that's adding fuel to the fire. You do not want to add a stimulant
to someone who already has high blood pressure. NARRATOR: Over time, high blood pressure
can damage the heart by eventually weakening the muscle. But after a thorough exam, she's surprised to find
nothing wrong. Uh-hm. I don't see anything acute, and the heart muscle is nice and firm.
So it's not from a heart attack. NARRATOR: But when she removes the heart from the chest cavity, she find something
completely unexpected. There's a five centimeter rip in Jason's aorta, the largest
blood vessel in the human body. The tear is located directly above Jason's heart.
DR. GARAVAGLIA: The aorta goes up from the heart. The portion that now yous see the tear in
is still in the pericardial sac. All the blood that was being pumped from the heart
was going into the pericardial sac. And that's what caused his death. NARRATOR: But it's clear to Dr. G that this is a fresh tear
and could not possibly have triggered Jason's initial bout of abdominal pain. That cardiac tamponade is something
that has happened very acutely. That heart sac filled up moments before he collapsed.
So I know he didn't have a cardiac tamponade two days earlier. But when you follow that aorta down into his abdomen,
there's actually a smaller second tear. And that tear is probably what he had two days ago.
And that's what was causing his abdominal pain. NARRATOR: The autopsy of Jason Mitchell is now complete,
but several questions still remain. What caused the two tears in the first place?
And could cocaine have played a direct role in his death? At this point, toxicology is important to me.
Because if it did have a role, it would be classified as an accidental death. And the wife of course, she's upset.
And the more of facts we can tell her, the better for her. [TENSE MUSIC] [MUSIC PLAYING]
NARRATOR: Several days later, Dr. G finally receives the results of Jason's toxicology tests.
The levels confirm that Jason didn't use cocaine in the hours before he died. But she does discovered trace amounts of cocaine metabolite,
a byproduct of the drug, which can linger in the body for days after using it. And for Dr. G, this finding is the key to the case.
Now that I see the traces of his cocaine use, it all fits. [TENSE MUSIC] NARRATOR: It's early on a Tuesday morning,
and Jason Mitchell starts the day as he often does, with a few lines of cocaine.
But what he doesn't realize is that his long term addiction to the drug has taken a devastating toll on his body.
[SNORTING] He's got some severe problems. NARRATOR: Jason has developed atherosclerosis in the blood
vessels of his brain. His heart has grown enlarged. And over the years, elevated blood pressure
compounded by cocaine use has made his aorta dangerously weak. So this guy has just about every complication
from cocaine you can imagine. NARRATOR: But on this particular day, one of those complications
is about to erupt into a full blown medical crisis. As Jason snorts another line of coke,
his body responds to the rush of the powerful stimulant. His heart rate and blood pressure spiked dramatically,
and then disaster strikes. A section of Jason's aorta near his abdomen begins to dissect or split, causing blood
to seep into the aortic wall. DR. GARAVAGLIA: That elevated blood pressure tears the inner lining, and the blood kind of goes
through the wall. NARRATOR: Almost instantly, he has overcome with searing abdominal pain.
His wife, Patty, rushes him to the hospital. But when he arrives, doctors dismiss the symptoms
as a benign result of his cocaine use. DR. GARAVAGLIA: Now, that is a serious problem.
They've missed that. He should have been hospitalized. There is a good chance they've had treated that medically.
But most ERs will miss about a third of those. NARRATOR: Jason returns home and promises
his wife to quit his cocaine habit, and it's a promise he keeps. The toxicology results show no evidence of cocaine,
only a trace amounts of cocaine byproduct produced as the body metabolizes the drug.
He had recently used cocaine since they told him to stop. Those two days, he wasn't using cocaine.
But the damage was already done. NARRATOR: As blood flows through the inner wall of the aorta,
the pressure rips through the layers of tissue. DR. GARAVAGLIA: That a section is going towards his heart.
A couple of days later, when he's making his way to the kitchen, the second tear
occurs in the pericardial sac. The blood just pours into the heart sac until it gets to the point where it expands the heart sac
and constricts the heart because of the pressure on the heart, so it can't expand and pump.
As soon as the heart can't pump, you're a goner and it goes fast. [SUSPENSEFUL MUSIC]
NARRATOR: When Dr. G delivers the report of autopsy to Jason's wife, Patty, she receives
the news with mixed emotions. DR. GARAVAGLIA: You know, she's devastated. I mean, she thought he'd finally was going
to turn it over a new leaf. And ultimately, his old cocaine habit is what got him.
You know, what I take away from this case is that people who are young think they're infallible,
but they're not. If you start using drugs, there is a good chance they're going to get you one way or the other.
[EMOTIONAL MUSIC]

Parents rush their baby to the hospital, but she tragically dies in her mother’s arms. Now, Dr. G must help these devastated parents understand what happened.

A Florida medical examiner takes viewers through puzzling cases while explaining procedures and conclusions.

Brief Summary

Dr. G investigates the tragic deaths of infant Anna Gaytan and young adult Jason Mitchell, uncovering rare medical conditions and the impact of cocaine use.

Key points

A Tragic Case of Infant Death. A seemingly healthy baby dies suddenly, leaving parents devastated and searching for answers.
The Pressure of Investigation. Dr. G faces the challenge of uncovering the truth behind a child's tragic death.
The Search for Answers. Dr. G's autopsy reveals no clear cause of death, leaving lingering questions.
The Tragic Case of Baby Anna. Dr. G uncovers the rare genetic disorder that led to baby Anna's death.
Jason's Sudden Collapse. After promising to quit cocaine, Jason collapses at home, leading to a tragic outcome.
Jason's Promise to Quit. Jason vows to quit cocaine for his wife, a promise he keeps.

Episode highlights

Episode quotes

Babies aren't supposed to die.

4:17WatchJun 22, 2021

Tension

75/ 100High tension

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